Medicaid Specialist

We need to output HTML fragment with sections for headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We must include only sections that have real specific content. The posting includes description of responsibilities, qualifications, etc. No explicit Benefits, Pay, Schedule. So we should not include those headings. We need to use

for section headings. Use

• for any list of duties/requirements/benefits, and

  for prose. We need to preserve all substantive info, not invent or summarize away detail. Remove boilerplate etc. The posting is all substantive; we need to parse into sections: About the role (maybe a brief overview), Responsibilities (list), Requirements (maybe qualifications), Qualifications (maybe overlapping), Skills (maybe communication etc). But we must not create sections with filler. We need to decide what content maps to which heading. The posting starts: "The Medicaid Specialist is responsible for the timely and accurate completion and review of Medicaid Pending applications..." That's basically role description. Could be About the role. Then many bullet-like sentences describing responsibilities. We can put those under Responsibilities as a

  • . Then "Required qualifications: Must have two years of work experience in Long Term Care...." That's qualifications. Could be under Qualifications. Also there are statements like "Must be efficient, maintain confidentiality, exhibit good judgment, and have the ability to speak and write effectively." etc. Those could be Skills or Requirements. We could combine under Requirements or Skills. Since we have both Requirements and Skills headings possible, we need to decide based on content. The posting includes "Must be knowledgeable of all Medicaid legal regulations, guidelines and best practices." etc. Those are qualifications/requirements. Also "Must possess good communication and people skills." That's skill. We could have sections: About the role (p), Responsibilities (ul), Qualifications (ul), Skills (ul). Avoid duplicating. We must not repeat job title as heading. No Job ID. We must not include Benefits, Pay, Schedule unless present. Not present. We must output only HTML fragment. Let's craft:

    About the role

    The Medicaid Specialist is responsible for the timely and accurate completion and review of Medicaid Pending applications to ensure all required documentation is made available and gathered for timely processing to the County. Further is responsible to ensure that policy and procedures in the business office are followed in accordance with current applicable Federal, State and local standards, guidelines and regulations. Ensures that all information uploaded into the billing software is accurate and completed promptly. Works one on one with residents, responsible parties, and families to ensure the Medicaid Application process starts within 24-48 hours of admission for any admission that will become Medicaid Pending. Secures authorizations to represent as applicable. Educates residents, responsible parties, families in the Medicaid Process and communicates documents required to complete the Medicaid Application. Informs Business Office Manager promptly if there is no cooperation or a delay in cooperation from a resident, responsible party, family in the Medicaid Application Process. Ensures complete confidentiality of financial, HIPAA protected information of residents. Responsible for the completion of the Options package for Aging and Adult Services for the clinical approval of Medicaid. Responsible for the tracking and ensuring the MA51 is returned from the physician timely. Further is responsible for ensuring the MA51 and the PASSAR match as it may result in a clinical denial. Responsible to forward the OBRA letter with the Medicaid application if the resident is deemed a Target admission by the Commonwealth of Pennsylvania and an Options request is not needed. Responsible for obtaining such documentation from the Social Services or Admissions Department. On a daily basis will call residents, responsible parties, families and financial institutions and other affected agencies and financial institutions to assist in attempting to obtain a large number verification that is needed by the Commonwealth of Pennsylvania to secure a Medicaid Grant. Responsible for ensuring Spousal cases include the additional information required by the County to ensure a timely processes and approval of a Medicaid Application. Responsible to ensure the resident and or responsible party or family member understands and signs the Patient Liability which is due on a monthly basis. Responsible to ensure that Direct Deposit if secured. Reports to the Business Office Manager if there is no compliance and a Rep Payee is secured for Social Security. Responsible to complete the Rep Payee Application and ensuring the Rep Payee Application is completed promptly and accurately. Responsible to keep and update the Medicaid Pending log on a daily basis. Works collaboratively with the applicable County office to ensure they have all required documentation. Responsible to attend face to face interviews at the County Assistance Office in order to secure a grant if families are uncooperative or unable to attend. Responsible for ensuring the County Assistance Office is in receipt of all verifications. Responsible for ensuring that when the Medicaid Grant is obtained the appropriate persons (third party biller, BOM and RNAC) are notified. Responsible for ALL active in-house Medicaid resident’s yearly recertifications. Comply with Health Insurance Portability and Accountability Act (HIPAA) regulations. Must be an active participant in the facility’s Quality Assurance/Performance Improvement (QAPI) program and Performance Improvement Project (PIP) and carry out roles and responsibilities as assigned. Must attend trainings for QAPI, follow policies and procedures in support of QAPI efforts, and support QAPI initiatives and findings. Must also report potential or actual non-compliance issues to the facility’s QAPI committee. Perform other reasonable duties as assigned by supervisor.

    That seems like a huge paragraph; maybe better to split into Responsibilities list. But the instruction: Use
    • for any list of duties/requirements/benefits, and

      for prose. So we could keep the overview as

      and then responsibilities as

      • . However the above paragraph already includes many responsibilities; we could split them into list items. Better: About the role: short paragraph summarizing role. Then Responsibilities: list each duty. Let's extract core responsibilities from the text: - Complete and review Medicaid Pending applications timely and accurately, ensuring all required documentation is gathered for County processing. - Ensure business office policies and procedures follow Federal, State, local standards. - Ensure information uploaded into billing software is accurate and completed promptly. - Work one-on-one with residents, responsible parties, families to start Medicaid Application process within 24-48 hours of admission for Medicaid Pending admissions. - Secure authorizations to represent as applicable. - Educate residents, responsible parties, families about Medicaid Process and communicate required documents. - Inform Business Office Manager promptly if there is no cooperation or delay from resident, responsible party, family. - Ensure complete confidentiality of financial, HIPAA-protected information. - Complete the Options package for Aging and Adult Services for clinical approval of Medicaid. - Track and ensure MA51 is returned from physician timely; ensure MA51 and PASSAR match to avoid clinical denial. - Forward OBRA letter with Medicaid application if resident deemed Target admission by Commonwealth of PA and Options request not needed; obtain documentation from Social Services or Admissions. - Daily call residents, responsible parties, families, financial institutions, other agencies to obtain large number verification needed by PA to secure Medicaid Grant. - Ensure Spousal cases include additional information required by County for timely processing and approval. - Ensure resident/responsible party/family understands and signs Patient Liability (monthly). - Ensure Direct Deposit is secured; report to Business Office Manager if no compliance and a Rep Payee is secured for Social Security. - Complete Rep Payee Application promptly and accurately. - Keep and update Medicaid Pending log daily. - Collaborate with County office to ensure they have all required documentation. - Attend face-to-face interviews at County Assistance Office to secure grant if families uncooperative or unable to attend. - Ensure County Assistance Office receives all verifications. - Notify appropriate persons (third party biller, BOM, RNAC) when Medicaid Grant obtained. - Handle all active in-house Medicaid resident yearly recertifications. - Comply with HIPAA regulations. - Participate in facility’s QAPI/PIP program, attend trainings, follow policies, support initiatives, report non-compliance. - Perform other reasonable duties as assigned. Now qualifications/requirements: - Must have two years of work experience in Long Term Care. - Must be efficient, maintain confidentiality, exhibit good judgment, and have ability to speak and write effectively. - Must possess good communication and people skills. - Must be knowledgeable of all Medicaid legal regulations, guidelines and best practices. - Must understand basics of working in the business office and importance of following established processes. - Must possess aptitude for problem solving. - Employment contingent on completion of pre-employment screenings: criminal background check and Medicaid Exclusion Screening, both negative. We could split into Qualifications (experience, knowledge, understanding) and Skills (communication, judgment, problem solving). But we can also combine under Requirements. Since we have both headings possible, we need to decide. The instruction: "Prefer a few substantive sections over many thin ones." So maybe we combine qualifications and skills into one section called Requirements or Qualifications. But we have both headings available; we need to use them only if there is real specific content. We could have: - About the role (p) - Responsibilities (ul) - Requirements (ul) covering experience, knowledge, understanding, problem solving, screenings. - Skills (ul) covering communication, confidentiality, judgment, writing, speaking, people skills. But that might be thin. However each has substantive content. Let's do:

        About the role

        The Medicaid Specialist ensures timely and accurate completion and review of Medicaid Pending applications, gathers required documentation for County processing, follows business office policies per Federal, State, and local regulations, maintains confidentiality, works with residents and families to start the Medicaid application process within 24‑48 hours of admission, educates on Medicaid requirements, coordinates with County offices, manages documentation such as MA51, PASSAR, OBRA letters, Options packages, Rep Payee applications, and daily verification calls, and participates in QAPI/PIP activities.

        That's a concise summary. Then Responsibilities list. Then Requirements list (experience, knowledge, understanding, problem solving, screenings). Then Skills list (communication, confidentiality, judgment, writing, speaking, people skills). We must not include Benefits, Pay, Schedule. Let's craft HTML. Be careful to escape any special characters? Not needed. We'll output:

        About the role

        ...

        Responsibilities

        • Complete and review Medicaid Pending applications timely and accurately, ensuring all required documentation is gathered for County processing.
        • Ensure business office policies and procedures follow applicable Federal, State, and local standards.
        • Verify that information uploaded into billing software is accurate and completed promptly.
        • Work one‑on‑one with residents, responsible parties, and families to start the Medicaid application process within 24‑48 hours of admission for Medicaid‑pending admissions.
        • Secure authorizations to represent residents as applicable.
        • Educate residents, responsible parties, and families about the Medicaid process and communicate required documents.
        • Inform the Business Office Manager promptly of any lack of cooperation or delay from residents, responsible parties, or families.
        • Maintain complete confidentiality of financial and HIPAA‑protected information.
        • Complete the Options package for Aging and Adult Services for clinical approval of Medicaid.
        • Track and ensure the MA51 form is returned from the physician timely; verify that MA51 and PASSAR match to avoid clinical denial.
        • Forward the OBRA letter with the Medicaid application when the resident is deemed a Target admission by the Commonwealth of Pennsylvania and an Options request is not needed; obtain this documentation from Social Services or Admissions.
        • Make daily calls to residents, responsible parties, families, financial institutions, and other agencies to obtain the large‑number verification needed by Pennsylvania to secure a Medicaid Grant.
        • Ensure spousal cases include the additional information required by the County for timely processing and approval.
        • Confirm that the resident, responsible party, or family member understands and signs the monthly Patient Liability.
        • Secure